Today, when I train new healthcare providers at the Valleywise Community Health Center - McDowell, it’s hard to convey how awful those days were during the early years of the HIV/AIDS epidemic in the United States. There are books, plays and movies that try to portray the era, but if you didn’t live through it, it’s difficult to impart the misery and despair we all felt – providers and patients alike.
Thankfully, HIV is no longer a death sentence. There is still no cure, but newer antiretroviral drugs have made HIV a survivable condition treatable with a single daily pill. And if one medication doesn’t work or causes side effects, there are many other options.
What’s more, preventive medicine is available for those at risk for contracting HIV. Approval in the past decade, pre-exposure prophylaxis, or PreP, has dramatically changed the prevention landscape for HIV.
Yet the more things change, some things sadly remain the same in HIV transmission.
Today, Maricopa County is one of 48 counties across the United States with the highest rates of new infections. More than 11,000 individuals in Maricopa County are living with HIV.
Many of those newly infected, particularly younger LGBTQ patients, don’t know about the utter horror of the early days, and simply don’t view HIV as a big deal. To those in their teens, 20s and 30s, the early 1980s is outside of their lifetimes. Further, many heterosexual patients still think of HIV as a gay disease rather than a STD that anyone can get.
Furthermore, 40 years after the first HIV/AIDS in the US, we’re still dealing with shame and stigma. Unfortunately, an infection that any of us can encounter is still perceived by some as a scarlet letter, rather than simply the luck of the draw that intimacy can bring. Only through open dialog about risk, testing, PrEP and staying on treatment can we be safe from HIV.
When I counsel patients today, it’s a much different conversation than in the 1990s when I treated HIV patients at the LA County Medical Center. Back then, it was reassurance about fighting a terminal disease; today’s it’s optimism about a long and full life –if a patient takes their medication every day.
I remember a home visit with a very ill young man in the early 90s who looked at the full moon outside the window and remarked, “I don’t think I’m going to live to see the next moon.” A month later I smelled every bloom in the hospital rose garden on my way into the hugs that greeted me in the clinic the day after attending his death at home.
It’s just one of the many stories of loss and coping that those of us impacted by the AIDS pandemic carry in our hearts forever.
Going forward, however, we can reduce and prevent new infections in Maricopa County through education around safer sex , the use of PreP and helping HIV+ patients stay in care with suppression of their viral infection. At Valleywise Health, we treat more than 4,000 patients living with HIV, and provide testing and PrEP to those at risk for acquiring the infection.
It’s important to recognize the 40th anniversary of the first AIDS cases in the US and appreciate that now a days NO one needs to get infected with HIV. For our HIV+ patients, the history begins when they get their HIV diagnosis - and that’s when we’ll be there to offer understanding and support, for many decades to come. For those not yet infected we implore you to reach out to use so we can help you stay HIV uninfected.
About the author
Ann Khalsa, MD, has worked in the field of HIV medicine since 1986. From 2006-2010 she was the Medical Director at the Centro de Salud Familiar La Fe HIV/AIDS C.A.R.E. Center in El Paso Texas which cares for over 1000 patients living on the US-Mexico Border. She held a clinical appointment as an Assistant Professor of Family Medicine at the Texas Tech University Health Science Center and also served as the Clinical Director at the Texas-Oklahoma AIDS Education and Training Center Local Performance Site in El Paso Texas. For the fifteen years prior to that she worked at the University of Southern California in Los Angeles as an Associate Professor of Clinical Family Medicine at the USC Keck School of Medicine where she also she served as the Director of Clinical AIDS Training for the Pacific AIDS Education and Training Center at USC, and chairperson for part of the medical school curriculum. During that time she cared for over 1000 patients at the LA County Rand Schrader and Maternal-Child AIDS clinics, and trained over 1000 local and international physicians in the care of HIV patients. She started off in the HIV field by doing four years of AIDS policy work through the Public Health Commission of the American Academy of Family Practice during medical school and residency.
Dr. Khalsa is certified as an HIV Specialist through the American Academy of HIV Medicine, has served on the national Board of Directors, the Academy’s Core Curriculum Committee to develop its “Fundamentals of HIV Medicine” self-study guide, and has authored chapters on Health Maintenance and antiretroviral therapy for treatment-experienced patients. She served on the Texas Steering Committee for the HRSA HIV/AIDS Bureau-National Quality Center Cross-Part Quality Management Collaborative, as well as on the Quality Management Committee of the Ryan White Title II Administrative Agency for the West Texas Health Service Delivery Area. She lectures on HIV-related topics to providers and patients alike, in both English and Spanish throughout the country and internationally.
She is board certified by the American Board of Family Practice, was awarded the US-Mexico Border HIV Hero Award in 2008, is a recipient of the Mead Johnson Award for Graduate Education in Family Practice, and a member of the Alpha Omega Alpha Medical Honor Society. Dr. Khalsa obtained her undergraduate degree from Pitzer College in Claremont California with honors in Psychobiology, and her medical degree from USC. She did her residency training at San Bernardino County Medical Center in California, holds master’s degrees in Biochemistry and Medical Education, and completed a Fellowship in Leadership Development at USC.
Dominic Miller is a social worker in a time of social distancing
Photo: Supplied
Professionally, he says he wants to improve health care systems for underserved populations. His goal is to provide more access to integrated mental and physical health services to these groups.
“I have experienced health care disparities as a minority myself and am committed to seeing our state and national health care systems change and improve,” he says.
Miller holds both a bachelor’s and master’s degree in social work, and a master’s degree in public administration, all three from Arizona State University.
“I provide individual therapy on a part time basis to a caseload of clients involved in the Federal Justice System,” Miller says. He is devoted to that and will always serve his patients one-on-one when he can.
This kind of dedication may come from his upbringing in a traditional but supportive family.
As a Latino, Miller is proud of his Mexican heritage and travels south of the border many times a year.
“I am obsessed with reggaeton, and love dancing to salsa and electric cumbia,” he says. ”I am lucky to have an uncle, Tio Ramon, who is a doctorate level specialist in
Mexican Art history, Diego Rivera, and Frida Kahlo, so I think I was inspired at a very young age. I am currently a bachelor but am very committed to being a dad of an adorable French Bulldog in the future.”
Often, Latinx men and women describe the difficulties of growing up gay in a traditional household.
Miller says that his wasn’t so bad, most of the difficulty came at a point of intersectionality.
“I remember constantly trying to identify with my different backgrounds and I think, like many of us, learned to survive by becoming a sort of a social chameleon before coming out,” Miller explains.“My family is very large — I have 30 first cousins, for example — and traditional in the sense that we come from communities with somewhat more conservative backgrounds.”
He identifies himself as a Chicano, or as he describes it, “a person of Mexican descent born in the U.S., but,” he adds, “I also am Italian and have some German heritage, hence my last name ‘Miller.’”
Perhaps the biggest conflict he had was with the Roman Catholic Church and later being a part of a Protestant evangelical community in college, “I remember my coming out process in college being confusing and painful because my church leaders did not agree with who I was and my decision to be the healthiest version of myself — out and supported. I eventually got to this point where I decided that others should not be afforded the decision to interpret my sexual identity as ‘wrong’ or ‘evil’, and I moved on.”
In fact, Miller says his ecclesiastical leaders may have been his biggest bullies growing up, not in a physical way, but an emotional one.
“I am happy to say that through my own healing process I can discern healthy boundaries and don’t harbor any hate or ill will to those who have different beliefs than I do.”
Luckily his parents were very supportive of his coming out process especially his mother who he calls the “the best person on the planet.” Although that might be true, it appears his whole family rallies together not only to support him but each other.
They are a clan of creatives full of talent and that allowed him to explore all the facets of himself.
“I think my parents wanted to make sure I was supported in finding who I was and allowing a place for me to home in on my interests,” Miller says. “I particularly cherished moments at my grandparent’s house in Maryvale on the west side of Phoenix. They lived there for decades and I can still remember smells of my grandmother’s cooking, her beautiful green garden, and a large stone statue of the Virgin of Guadalupe in the backyard.”
When he was 21, Miller took on another task, perhaps paying forward all the support he got from his own family. He was matched with a student through a non-profit program based just west of Downtown Phoenix called Neighborhood Ministries. He mentored this student all the way through high school.
“He then went on to study out of state at a college on a scholarship. He’s an amazing person and I learned so much from him. His family moved to Arizona from Mexico when his mother was pregnant with him to provide him and their family an opportunity for a better future.”
That future may lie in how Arizona votes at the polls. Miller says Latinos are slated to be the largest voting minority group in 2020. “I’ve read reports that Krysten
Sinema won the U.S. Senate seat over Martha McSally by the small margin of 2.3%. With stakes that close, it is absolutely imperative that everyone who can vote, does vote. I think Latinos have a huge presence in Arizona and should be involved in forming the political landscape of the state through voter representation.”
As previously stated, Miller is Vice President of Outpatient Services at Southwest Behavioral and Health Services. He also oversees other programs at the facility such as their clinical and administrative operations of programming in Maricopa, Gila, Yavapai, and Coconino counties.
“I get to travel to Payson, Prescott Valley, and Flagstaff often and I love it,” he says.“ Needless to say, I’ve never been busier in my life, but I truly feel grateful to have landed what I consider a dream job very early in my career. I supervise a fantastic team of directors and really would be nothing without them.”
Since taking the position as Vice President, Miller is working with his clinical team to develop programming specifically for LGBTQ+ adults and adolescents, “I would never take full credit for that though, I have an amazing team that did the majority of that work. We would love to expand this kind of work in rural areas in Arizona where there is less support.”
Since the curve of the pandemic is still moving on an upswing, Miller and his staff are taking care of patients as it is considered an essential business. They have moved the majority of their services to telehealth and telephonic methods of delivery.
“It has been quite the challenge moving everyone over to telehealth seemingly overnight, but I am happy to say we are doing very well through all of the changes and anxiety a pandemic provokes,” Miller explains.
As for more people needing more mental health care services during the pandemic, Miller says the necessity is there especially for people who are already suffering from depression or social isolation. He says it’s “important for them to stay connected and find new ways to cope with challenges at a distance from others.”
In the end, Miller just wants people to be aware of mental health issues and how they intertwine with physical ones. He adds that being informed helps break down stigma and the obstacles to getting important healthcare.
“A lot of gaps in care can be linked to what we call ‘the social determinants of health’ or economic and social conditions that influence health status,” he says, “I would say get involved, know your community and the different agencies doing the work and find out ways to volunteer or help. I always encourage my friends and family to be thoughtful and consider that everyone has their own mental health and physical health journey. You will never know someone and understand how you can help them without openness, empathy, and a willingness to listen to their story told by them. Also, health care workers are truly on the frontlines of this pandemic right now, so if you know one, thank them.”